MEDICARE: FAMILY EYE CARE GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011KX	OTHER	NC	BCBS GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134170368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EYE CARE GROUP INC

Provider Business Mailing Address
First Line	:	113 SALEM TOWNE CT
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-2311
Country	:	US
Telephone Number	:	919-367-8411
Fax Number	:	919-367-8431

Provider Business Practice Location Address
First Line	:	113 SALEM TOWNE CT
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-2311
Country	:	US
Telephone Number	:	919-367-8411
Fax Number	:	919-367-8431

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. MICHAEL MARINO
Credential	:	OD
Telephone Number	:	919-367-8411

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/29/2008

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